This report describes patterns of dispensing of respiratory medications in Australia through detailed analyses of Respiratory medication use in Australia Pharmaceutical Benefits Scheme (PBS) data, as well as other sources, to draw inferences about respiratory 2003–2013 medication use among patients with asthma and COPD. It provides a valuable update and new information Treatment of asthma and COPD about the use of medicines for asthma and COPD, thus improving our knowledge and understanding about how these diseases are managed in Australia. ACAM Australian Centre for Airways disease Monitoring Respiratory medication use in Australia 2003–2013 Treatment of asthma and COPD Australian Institute of Health and Welfare Canberra Cat. no. ACM 31 The Australian Institute of Health and Welfare is a major national agency which provides reliable, regular and relevant information and statistics on Australia’s health and welfare. 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Enquiries relating to copyright should be addressed to the Head of the Digital and Media Communications Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601. A complete list of the Institute’s publications is available from the Institute’s website <www.aihw.gov.au>. ISBN 978-1-74249-715-0 (PDF) ISBN 978-1-74249-716-7 (Print) Suggested citation AIHW: Correll PK, Poulos LM, Ampon R, Reddel HK & Marks GB 2015. Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD. Cat. no. ACM 31. Canberra: AIHW. Australian Institute of Health and Welfare Board Chair Acting Director Dr Mukesh C Haikerwal AO Ms Kerry Flanagan PSM Any enquiries about or comments on this publication should be directed to: Digital and Media Communications Unit Australian Institute of Health and Welfare GPO Box 570 Canberra ACT 2601 Tel: (02) 6244 1000 Email: [email protected] Published by the Australian Institute of Health and Welfare This publication is printed in accordance with ISO 14001 (Environmental Management Systems) and ISO 9001 (Quality Management Systems). The paper is sourced from sustainably managed certified forests. Please note that there is the potential for minor revisions of data in this report. Please check the online version at <www.aihw.gov.au> for any amendments. Contents Acknowledgments.............................................................................................................................. iv Abbreviations ....................................................................................................................................... v Summary .............................................................................................................................................. vi 1 Introduction .................................................................................................................................... 1 Rationale for this report................................................................................................................. 1 Classes of medications ................................................................................................................... 2 Management guidelines for asthma ............................................................................................ 6 Management guidelines for COPD.............................................................................................. 7 Context of this report ..................................................................................................................... 8 Questions considered in this report ............................................................................................. 9 2 Data and methods ....................................................................................................................... 10 Data sources .................................................................................................................................. 10 Methods of data analyses ............................................................................................................ 13 3 Use of medications for obstructive airway disease............................................................... 21 Overall medication use ................................................................................................................ 21 Use of SABA for asthma (NSW Health Survey) ...................................................................... 23 Corticosteroids .............................................................................................................................. 25 Long-acting bronchodilators (LABA and LAMA) prescribed without ICS ......................... 49 Anti-immunoglobulin E therapy (omalizumab) ...................................................................... 52 Leukotriene receptor antagonists ............................................................................................... 55 Use of asthma medication in children (LSAC data) ................................................................ 59 4 Discussion and implications ..................................................................................................... 61 Appendix 1: PBS items included in the analyses for this report ............................................... 63 Appendix 2: PBS data processing .................................................................................................... 64 Appendix 3: Inhaled corticosteroid potency classification ........................................................ 66 Glossary ................................................................................................................................................ 68 References ............................................................................................................................................ 73 List of tables ........................................................................................................................................ 76 List of figures ...................................................................................................................................... 77 Related publications .......................................................................................................................... 79 iii Acknowledgments The authors of this report were Patricia Correll, Leanne Poulos, Rosario Ampon, Helen Reddel and Guy Marks of the Australian Centre for Airways disease Monitoring (ACAM) at the Woolcock Institute of Medical Research, University of Sydney. The report was reviewed by Louise York, Tomoko Sugiura, Lisa McGlynn, Jenny Hargreaves, David Whitelaw and Geoff Neideck from the Australian Institute of Health and Welfare (AIHW), and the members of the National Asthma and Other Chronic Respiratory Conditions Monitoring Advisory Group. Preparation of this report was guided by members of the Asthma and Other Chronic Respiratory Conditions Advisory Group: Michael Abramson, Amanda Barnard, Anne Chang, Alan James, Peter Gibson, Christine Jenkins, Graeme Maguire, Chris Pearce and Judy Raymond. Their contribution is gratefully acknowledged. This publication was funded by the Australian Government Department of Health. iv Abbreviations ABS Australian Bureau of Statistics ACAM Australian Centre for Airways disease Monitoring (formerly Australian Centre for Asthma Monitoring) AIHW Australian Institute of Health and Welfare ASGC Australian Standard Geographic Classification COPD Chronic obstructive pulmonary disease COPD-X This is the name for Australian clinical practice guidelines for COPD. The name is an acronym for the key components of COPD management. DUSC Drug Utilisation Sub-Committee DHS Department of Human Services ICS Inhaled corticosteroids IgE Immunoglobulin E LABA Long-acting beta2-agonists LAMA Long-acting muscarinic antagonists LSAC Longitudinal Study of Australian Children LTRA Leukotriene receptor antagonists OCS Oral corticosteroids pMDI Pressurised metered dose inhaler PBS Pharmaceutical Benefits Scheme RPBS Repatriation Pharmaceutical Benefits Scheme SABA Short-acting beta2-agonists SAMA Short-acting muscarinic antagonists SEIFA Socioeconomic Index for Areas SES Socioeconomic status v Summary This report focuses on medications dispensed for asthma (a chronic airways disease affecting children and adults) and chronic obstructive pulmonary disease (COPD, which primarily affects older adults who have been smokers). In 2013, one or more respiratory medications were dispensed to 2,042,104 people in Australia (9.1% of the population).